Individual
FREDRICK SUTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 BEECH BRANCH CT, IRMO, SC 29063-8046
(803) 920-7744
(803) 407-2957
Mailing address
15 BEECH BRANCH CT, IRMO, SC 29063-8046
(803) 920-7744
(803) 407-2957
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EX5221
—
SC
Enumeration date
11/07/2006
Last updated
07/08/2007
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